Charity Dean, MD, MPH&TM, Transcript

[00:00:01.330] Announcer:

America’s healthcare system is almost unanimously viewed as being unaffordable, dysfunctional, and severely in need of transformation. APG President and CEO Don Crane talks with leading healthcare executives, physicians, and other visionaries to explore solutions to lower costs and improving quality of care by accelerating the movement toward value-based care models and away from fee-for-service. Want to be inspired by our nation’s foremost thought leaders in healthcare? Then this show is for you. Here’s your host, Don Crane.

[00:00:35.710] Don Crane:

I had the privilege of speaking the other day with Dr. Charity Dean, the lead character in a best-selling book recently authored by Michael Lewis entitled, “Premonition”. The book is a riveting…and disturbing, actually…account of the COVID-19 virus’s largely unchecked spread across the United States, an indictment of the abysmal response of our public health authorities to protect us from this communicable disease and important problems to come if we don’t develop an effective response in the future. In the book, Charity is a bright, fearless tour de force in her efforts to awaken our public health system of the perils of COVID-19. In our interview, she has all of that and more. I think and hope you’ll like her as much as I did, because she will be a featured keynote speaker at our annual meeting in San Diego, December 9 through 11. Registration is open. Just go to the APG. org web page to register and see Charity Dean in person. Now to the podcast. Hope you enjoy it. Take a listen.

[00:01:46.730] Don Crane:

Doctor Dean, great to have you with us today. Charity, if I may call you.

[00:01:51.530] Charity Dean, MD:

Of course.

[00:01:52.610] Don Crane:

Very good. So let me start, Charity, quickly by going through the high points of your CV just so our audience knows. And of course, we’re also looking forward to having you be a keynote at our annual conference in December. And so, this is a bit of a kind of prelude to it, I think, or a sneak preview or something. So, you were the health officer for Santa Barbara County Public Health Department for a period of time. You moved to a position as Assistant Director of the California Department of Public Health up in Sacramento. You’re the CEO and Co-Founder of The Public Health Company, this most interesting company that you’ve formed that we’re going to want to talk about. And then finally, also not insignificantly, you’re the subject, in fact, the protagonist of a best-selling book out by Michael Lewis, entitled The Premonition: A Pandemic Story. So, those are the high points of the most amazing resume. I think with that, let me start on a light note, Charity. What’s it like to be the protagonist of a best-seller and read about yourself.

[00:03:00.230] Charity Dean, MD:

You know, it’s strange. I don’t believe the hype around me being a hero or doing anything special or noteworthy because all I’ve ever done is my job. And I always took it very seriously when I took my oath of office to protect the country against all enemies, foreign and domestic, and definitely considered pathogens part of that oath. And so, when Michael Lewis found me, and it took quite an effort for him to reach me, it was a little bit baffling why he was interested in my story or the work I had done. And I didn’t realize I was the main character in the book until about December, and at that point I’d spent about six months teaching him microbiology and public health, and I didn’t read the book until it came out.

So, I had no idea what was going to be included until the rest of the world read it.

[00:03:54.290] Don Crane:

So, but in your defense, if I may, once upon a time I actually was a lawyer. So, I think you’re great, and we all would agree with that. But what makes it so interesting in your role in the book and in the drama that is the pandemic is all the resistance you encounter and that’s sort of emblematic of the larger dysfunction associated with the national response. So, it’s you, but it’s also what you face and what you did. I think it’s an amazing book and that your work was phenomenal and yet you got picked and you’re now a star, Charity. I think it’s great.

[00:04:33.710] Charity Dean, MD:

Yeah, thank you. It’s a little bizarre to me, and I tend to ignore a lot of the hype and attention around the book and just put my head down and do my job. They’re busy at work making the movie right now, and so I’m trying to be as helpful to them as I can be. It’s important that microbiology is right in the movie. I’m thrilled that it gives people a forum to discuss the issues that happen during the pandemic, and I’m thrilled that it does highlight what I would say is the theme of the book, which is individual vigilance absent a system will always fail.

[00:05:06.110] Don Crane:

Well, you know, I’ll ask a question or two about whether we learn anything and if we’re going to be prepared for the future. But one would hope that the book facilitates that and that a movie likewise continues that process and facilitates the learning so that we’re a smarter nation in the future, I would hope…that’s my personal hope, so cross our fingers. Not all movies are really faithful to the subject, so I hope your guidance and advice that you’re giving whoever’s starting the movie will succeed.

[00:05:39.530] Charity Dean, MD:

I hope so, too. And I think you’re absolutely right that the goal is to let the book carry a message and launch a national conversation that can get us into solutions. And that’s why I agreed to it in the beginning when Michael asked me to be what I thought was a character, maybe with one paragraph about them in the book, I said, if this has the power to move our country towards system solutions that can protect and defend the United States, I’m all in for that.

[00:06:08.450] Don Crane:

Hoorah and amen in a time of such misinformation to have an accurate book, which I think it is and followed by an accurate movie. This will be, I think, a very useful thing for the country, for public health. So anyway, my fingers are crossed with you. So, let me ask you very, very generally, how did we do with this…and we’re in the middle of the pandemic, I recognize it, or perhaps in the latter innings, but it does still feel as though we’re in the middle of it. And when I asked how we did, the ’we’ is, of course, national and it’s state and it’s county, and then it’s, I think, private enterprise and maybe even as individuals. So, I’ll just throw it out there as this very open question, and we can talk about testing, we can talk about vaccination, we can talk about hesitancy, and so on. But just as a general precept, how did we do?

[00:07:02.150] Charity Dean, MD:

I would say we, as humans, were heroic. That the healthcare workers, the scientists, the public health officials, the volunteers, the general public, everyone that ran to the fight and gave it their all and some of them gave their lives are deeply moving. As a system or as institutions, this was a colossal failure by the United States. Our systems and institutions failed. Our humans didn’t fail. And truly, that’s what gives me hope that we can build a system to plug our humans into because we have the grit, we have the fight, we have the will as the American people to rise to the occasion. And so, as much as I would absolutely describe it as a failure by the United States of America systems and institutions, I think there’s all kinds of sparkly hope in this response. And many of those examples, like Operation Warp Speed, are leading to system solutions now. And I think failure, you know, what I know from running disasters and running outbreaks, is that the after-action that we have, which is really a post-mortem on the failure, has to include a searching and fearless examination of the layers of Swiss cheese that failed so that we can put mechanisms in place to ensure it doesn’t fail again. It can’t be personal. The moment we start blaming the failure on one governor or one President or one healthcare worker or one faction of the American people, then that’s when we don’t allow ourselves to stand up a real solution. So, I think not just acknowledging the failure, but then acknowledging the parts that failed, that’s what gives me hope that we can actually build something that works.

[00:08:57.890] Don Crane:

So, I’m new to public health here…is it reasonable to expect that there will be a very formal kind of post-mortem? Is that the kind of thing that CDC does, or do we need Congress to step in and ask for a thorough, kind of a non-biased, nonpartisan evaluation?

[00:09:17.810] Charity Dean, MD:

Well, I think it’s an important question. And I think what you said in thorough, non-biased, is most certainly the key. On that note, it most certainly would not be the CDC. That kind of thorough examination would need to be nonpartisan, cross-sector, including public and private, and academia and philanthropy. And there’s a number of efforts that are working behind the scenes right now. I’m part of one of them, and they’re doing an incredible job of starting to lay the foundation for that kind of post-mortem. The question will be if it’s authorized and blessed by Congress and or the White House, and if it’s able to be truly searching and fearless and not afraid of what they might find. If they find that an entire institution has failed, it needs to be reworked, we have to be brave enough to say “let’s fix it.” It’s dangerous when you do an after-action.

[00:10:13.850] Don Crane:


[00:10:14.450] Charity Dean, MD:

Just like the decision to test is the decision to treat as a doctor, the decision to do an after-action that’s searching and fearless is the decision to address the problems you find. And that’s what I am curious to see if our country is willing to do.

[00:10:28.610] Don Crane:

We’ve done it in the past, in other instances where it’s worked well. I think Warren Commissions and the like, but the January 6 effort has not been nonpartisan, and we’re in a very kind of divided time. So again, I guess I’m going to have to cross my fingers that we get that sort of…I like those words searching and fearless evaluation…because I think that we’re going to find the patient was ill and some very important particulars. So, talk to us…why don’t we start…my impression is that we did amazingly well in terms of the development of a vaccine, and you can respond to that. But also, amazingly poor in terms of testing and containment and basically prevention. So, speak to testing and containment.

[00:11:19.130] Charity Dean, MD:

Sure. Well, I certainly agree with your sentiments. I would start with saying the US did not even try to contain COVID-19. There was zero containment effort. At the state level, state health officers were waiting for the CDC to sound the fire alarms, (as) I describe it. But there really is no fire alarm in this country. Instead, containment relies on the individual vigilance of local health officers on the front lines and doctors and ERs when a symptomatic patient comes in with influenza-like illness. Containment, by definition, is local. And in this scenario, because state health officers were waiting for the CDC to sound a fire alarm that didn’t exist, local health officers were waiting for the state to sound a fire alarm that didn’t exist. And the healthcare system was waiting for local public health to sound a fire alarm. And so, the failure of containment or failure to even launch containment, I would again describe as a systems problem, because within that system, there were amazing doctors and health officials who would have and were trying to contain the virus in their community. But absent any kind of centralized intelligence or identified threat level, they were largely on their own. So, we saw individual actors. For example, when I was at the state, I would get phone calls from my colleagues in ERs, infectious disease doctors, ER docs, local health officers telling me what they were seeing and asking, was this real? Was this a threat? And what was the containment effort? So, the humans wanted to contain it, but the system didn’t allow them to. And it dovetails with testing certainly in that the failure for the United States to have a test. And I don’t mean a healthcare diagnostic test. I mean a public health test like rapid test. The fact that we didn’t have any of that capability in January meant that we were flying blind. And when Paul Markovich and I were asked to stand up a testing task force and assemble it and lead it, at that point we had already lost our chance at containment. So, not only were we flying blind, but the most important question at the beginning of any outbreak is how many undetected cases are circulating in the community right now, and we couldn’t answer that question.

[00:13:46.310] Don Crane:

I remember press reports when people were kind of reluctantly coming to the conclusion that we missed the boat on testing and lost the opportunity to thwart this thing. And this was at about the same time, I think that the administration basically said, okay, 50 states, you’re on your own. It struck me as being pretty fragmented. For people like myself to look at a pretty siloed and fragmented health delivery system, to watch the public health system or non-system be even more fragmented and siloed was pretty distressing. Did I get that right?

[00:14:29.070] Charity Dean, MD:

Yeah, you did. And I describe it as a patchwork quilt. And on some level, it didn’t surprise me that the White House essentially deferred to governors who then deferred to counties. It didn’t surprise me because I know from being a local health officer, no one’s coming to save you. There’s no backup on the front lines. And as Michael Lewis and I talked about at length, and he described in the book, the system, the current system, is set up to put the most responsibility and burden on those that have the least amount of social power, which is the local health officer. These are folks who are underpaid under-resourced, and yet they are the front lines of national security for the country. And so, I knew all of that. And it didn’t surprise me that the White House would defer to governors who then put the burden on local health officers who then have their heads chopped off by their local board of supervisors. That’s the current system that we have and it’s a patchwork quilt.

[00:15:35.370] Don Crane:

So, let’s shift gears and talk about the vaccine. So, I heard over and over that this is one of the greatest successes, basically, in medical science and the history of mankind, the development of the vaccine in such a fairly quick time period. Would you agree with that? Would you comment on that?

[00:15:54.870] Charity Dean, MD:

I would agree with that. I would say science rose to the occasion. It’s one of the shining victories of the response, and potentially one of the only ones from a system’s perspective, that Operation Warp Speed was a huge success, and it’s because they had amazing humans leading it. But they also had trained for that kind of scenario and very quickly pulled together the right people through public and private and academia, drove hard and fast forward on a really short timeline. And the way it’s been described to me by some of the individuals that led it, that the principles of agility, focus, and convergence are the most important in that environment, and they had those. They had agility, they had focus, they knew exactly what they had to do, and they had convergence with multiple different work groups dovetailing together to achieve a common goal. I think the vaccine is an example of how we can move fast, innovate, and come up with a solution using science and best practices. And thank God for the vaccine, it’s been an absolute game changer, and I know that we, all of those involved in the response, learned a ton from watching that. And I think the biggest take-home lesson is we can build fast-moving, nimble operations to respond in real time.

[00:17:20.370] Don Crane:

So, it’s been a long time since the Spanish flu in 1918, and of course, there’s been pathogens between then and now, but nothing quite like the Spanish flu in here now. I think our fatality numbers have actually exceeded those experiences in the United States back in 1918. So, as I look forward, though, I fear it is the case, sort of inevitably, that there will be more contagious diseases and pathogens in the future. I assume you’ll agree with that. But the question is, have we learned much, if anything, will we’d be better prepared? What do you think?

[00:18:01.710] Charity Dean, MD:

Well, I love 1918…I love history in general, the history of infectious disease, and looking at where our country and the world is today, I do not believe that we are any better prepared today, with the exception of vaccines. So, medical countermeasures aside, I do not believe that our public health infrastructure is any better prepared today than we were two years ago. And looking at the pathogen in 1918, the death curve from 1918 is in the shape of a W, meaning 0-to-five-year-olds, 20-to-30-year-olds, and then elderly had very high mortality rates, and it’s a very different shape from the death curve that we see today with COVID. And so, what I worry about most is that COVID was not the big one and that there is a worse bio threat that’s coming in the very near future, and when it reaches our shores, if it had a case fatality rate of 5%, 10%, and if it had the component of asymptomatic or pre-symptomatic spread…and if the case fatality rate included that W-shaped curve where it killed children and young and healthy working adults, the economic and national security concerns would be far greater than they even have been with COVID. So, as devastating as the COVID pandemic has been, I do not believe it’s the worst pathogen we’re going to see. I believe something that’s a greater threat is coming and our system is no better prepared at this point.

[00:19:40.110] Don Crane:

Ugh, I guess would be my reaction to that, which brings me to another ugh reaction that I have, which is vaccine hesitancy and our sort of inability to get to herd immunity. Would you speak to that? I mean, I’m told that vaccine hesitancy is expected. That public health officers know that there’s going to be some amount of that but it strikes me as though we’ve got a lot on our hands and that it is a major impediment to putting this behind us. Is that the case and what should we do different?

[00:20:13.590] Charity Dean, MD:

Sure. Well, I have so many thoughts around vaccine hesitancy. It’s one of my favorite issues by default. And it’s because when I was Health Officer of Santa Barbara County when Senate Bill 277 was passed in California around school vaccine mandates and the ability to file a medical exemption or a personal belief exemption for the vaccines for children. And so, I was very engaged in this issue by default simply because there was so much backlash. And I, as local Health Officer, oversaw the vaccination program and made a decision during that time that my role was to protect the most vulnerable, and that included children who were too young to get vaccinated, children with underlying health conditions, and that I had to be their voice and their defense to make sure that everyone else was vaccinated around them. And so, when COVID started one of the…you know, I talk a little bit about dirty math…I’m not a mathematician, I’m not a data scientist, but I do dirty math, which is the equation for herd immunity is one minus one over R-naught. So, in January, what I was trying to figure out is how close or far are we from herd immunity and how many people will have to be immune to reach one minus one over R-Naught when you assume an R-naught of two or 2.5 or three. And then once people stay at home and you reduce the R-naught to maybe 1.2, then how do we achieve herd immunity? And so, I love the conversation of herd immunity and vaccine hesitancy. It’s played such a major role in the United States that there’s a whole faction of Americans who will not get vaccinated, which impacts our herd immunity and means that the COVID pandemic stretches out for our country much longer than it needs to. And on the same note, when you don’t achieve herd immunity, every person that’s infected with COVID is a walking test tube of mutations accumulating. This genome mutates about once every two weeks. And so, vaccine hesitancy means we have thousands of walking test tubes, which is why we see variants like the Delta variant emerge with an R-naught of six to nine. So now, if you do one minus one over R-naught, your threshold for achieving herd immunity is much, much higher. And so, the vaccine hesitancy that really, certainly in California, goes even back to school vaccine laws and mandates that local health officers grapple with all the time. That threat to national security or threat to health security, it’s been around a really long time. We even saw it during 1918. So, I think that if our goal is to achieve herd immunity, whether it’s through vaccinations or natural immunity from infection, we need a better strategy for dealing with vaccine hesitancy because we know on the front lines that is the number one factor that has to be overcome, certainly for children. But now we’re seeing in the pandemic, for adults.

[00:23:22.590] Don Crane:

So, is the answer more carrots or sticks or some of both, or what’s a good strategy for that?

[00:23:32.130] Charity Dean, MD:

It’s interesting because the natural inclination, I think, of doctors is to get a little bit preachy, and it’s certainly mine. I’ve had to really check myself when I’ve wanted to cite scientific papers about vaccine efficacy and safety. What we know from research on this in public health is that that strategy doesn’t work, that using compassion and empathy and identifying with the deeply held beliefs and fears is far more impactful. And I’ve witnessed that on a county and state level that all parents love their children and want to protect their children and keep them safe. So, if we start from there, then we start from common ground, and then we can understand why there’s fear and anxiety around something that they’re worried could harm their children or harm themselves. So, I think finding the common ground and starting from there is a much more impactful approach than banging someone over the head with academic research.

[00:24:35.130] Don Crane:

So, that sounds like education/persuasion. In other words, get the vaccine despite your hesitancy to basically protect your children and your parents and friends in the community. Is that kind of the message that needs to be better delivered?

[00:24:53.610] Charity Dean, MD:

I think it is. And that was the message that I began using in 2016 is that we get vaccinated to protect the vulnerable in the community, to protect the children around us who can’t get vaccinated. And in COVID, we get vaccinated to protect our loved ones and their loved ones. We get vaccinated because we love the people around us, and in that way, it’s not just taking care of our loved ones, but it’s also a sense of responsibility. I think Americans are really good at that about being responsible for each other and caring for our neighbors. But I also worry that that’s part of American culture that’s kind of slipping away as we see social media platforms amplifying voices of conspiracy theorists and anti-science folks that we can’t just think of communities anymore as our streets or our neighborhoods. Communities have become online communities now. And I worry about the direction that’s taking us.

[00:26:35.430] Don Crane:

Let me shift now to this most fascinating undertaking of yours which is The Public Health Company. So, although I think I can guess the answer, let me throw you a softball. Why have you started this most interesting company before I get to ask, what you’re going to do? Is it because no one is coming to save us and you, frankly, needed to roll up your sleeves and create a kind of a private solution to supplement or replace, or whatever, public governmental solutions?

[00:27:08.850] Charity Dean, MD:

My answer has actually evolved since I launched the company. I’ve learned so much. I’ve learned so much. When I initially launched the company, it was a difficult decision because I loved working for the governor. The team at California are amazing public servants, and it was really difficult to make the decision to leave. But when I did that and launched the company, it was because I realized that the kind of innovation that would be needed to stand up real-time intelligence for the benefit of all needed to come from Silicon Valley. And I learned in public service, you know, here I sat in California with the most forward-leaning, innovative governor with volunteers from Silicon Valley at our fingertips, by our sides, working on and yet we couldn’t develop the technology that was needed. And I realized that the real-time intelligence and not just intelligence on disease now-casting and forecasting, but risk analysis that I believe very much that that was software and the only way to scale a local health officer or a data scientist or an infectious disease doctor to give that kind of a capability to the private sector companies that employ our essential workers was to put it in software. And it mystified me at first because the tech revolution clearly has not hit disease control or public health. And so, I would be inventing something new that didn’t exist before with my bare hands. And that was pretty intimidating. But as I saw the amazing humans in Silicon Valley that were rallying around this effort, it gave me relief that I wasn’t doing this alone, I had a lot of talented folks around me. So, I think my short answer today would be very simply that bringing a tech revolution to disease control needs to involve the same thinking and the same strategies as many of the social media platforms that we use every day. The technology exists to create real-time intelligence. And that’s what we’re building.

[00:29:21.630] Don Crane:

So, tell us about this most interesting company. I see the tagline on the web page “Prevent Detect Contain.” It seemed to be the key words there. So, tell us about the company. Tell us what you sell, products, services. Let us understand what it is.

[00:29:38.970] Charity Dean, MD:

Sure. Well, The Public Health Company….so, I launched it about one year ago, and we’re up to about 26 team members, and we’re unique because what we’re doing is taking the thinking of the best disease controllers and data scientists and putting that into software that can actually scale across globally-distributed enterprises. And so, that involves certainly disease now-casting and forecasting. But I think the heart of it is really the risk analysis of quantifying biosecurity risk and then translating that into really practical answers. I’ve learned so much about the hard decisions on the plates of corporate CEOs. They just need to know from a practical perspective, what do I do now to protect my supply chain or protect my revenue streams, to protect my workers? And if we could replicate the thinking of a local disease controller and put them right behind the CEO and a C-suite making these hard decisions for their company, what would that look like? And so, we are working with a number of early what I think of as founding clients to certainly deliver services and intelligence and real-time risk analysis as they make these decisions. But as we do that, we’re also building out the underlying platform so that we can scale that kind of expertise, guidance, and risk analysis on a much larger scale than any one human could. And it’ll be a long-term effort. This will be a labor of love. This is going to take us many years to build out those tools and capabilities towards the longer-term vision of a scalable biosecurity platform.

[00:31:23.250] Don Crane:

Who do you see as your customers today or potential customers tomorrow?

[00:31:28.710] Charity Dean, MD:

Today, the vast majority of what we do is engage with the private sector, and part of the reason is my old motto of ‘no one is coming to save you as a local health officer’. That is infinitely more true in the private sector. Many of the large corporations that are the pillars of the US economy, they don’t even have chief medical officers, they don’t have infectious disease doctors and data scientists at their fingertips, and they’ve largely been left to fend for themselves. And so, our focus right now is delivering expertise to those globally-distributed private sector enterprises. And as we build out our tools and our platform to be able to scale, we absolutely are going to be engaging the public sector. I hear from states, local health departments, (and) federal departments all the time with interest and desire to use this kind of platform. And so, we’re learning. First and foremost, I’m willing to try something and fail and build something and test it out. And so, we’re very much in a learning and building phase right now, knowing that scaling those tools to healthcare systems, to hospitals to the public sector is definitely where we’re headed. But first and foremost, it’s the private sector that needs support right now.

[00:32:49.710] Don Crane:

So, I have a theory that we have a match here between your organization and mine, Charity. So, telling you what you already know, my members are principally prospectively-paid, a fancy word for capitation. So, many of my members will have two, three, four, 500,000 lives they’re responsible for, right? They are prepaid to take care of that population. Pandemic pathogen strikes and all of a sudden all of those patients get sick. My members go under water. I mean, we’re clearly responsible for the total cost of care. My members, I think, are highly adept at mining their own data, stratifying their populations, taking good care of diabetics and hypertensives, and so forth. But I daresay, I’m thinking aloud as I talk right now, hope I don’t misstep…that my members are not particularly adept yet at pathogens. Novel viruses. And what you’re talking about is a new sort of science for them that they would be highly interested in. I’m really looking forward to your talk in December, and I think as we kind of prepped for, we should really be kind of talking about the marriage of your software and public health approach with my members. Currently, we’re using machine learning and artificial intelligence and so forth. But to marry these two kinds of somewhat disparate sort of efforts in a more holistic way because I think we’re natural allies in terms of trying to keep a population healthy and day-to-day routine stuff, but also healthy when a pathogen strikes. Does that sound like a reasonable theory?

[00:34:44.130] Charity Dean, MD:

Yeah, I think you’re spot on because what you’re talking about is population-level risk analysis and risk-mitigation. Most doctors are very good at thinking about the differential diagnosis for one patient. And what are the odds of them having X, Y, and Z disease? But thinking that way for a population is a different kind of risk analysis. And up to this point, it’s been largely by individual vigilance for communicable disease, and I absolutely love risk analysis of communicable disease. I would make a differential diagnosis, for example, during the meningococcal outbreak, I would make a differential diagnosis for the community based on scattered data from unreliable sources under a high-stakes scenario where if I was wrong, kids died and I was fired. And if I was right, there was no prize or no parade or no recognition from being right. It was catastrophic because that meant that the outbreak was real. And so, I think applying the population-level risk analysis for infectious disease to healthcare systems or payer systems is spot on. And right now, no tools exist to do that. And I think part of the challenge is, historically, communicable disease has been kind of the less glamorous part of public health. People think that those diseases are a relic from the last century, and so they don’t think about them as much as they should. But the threat is enormous. Like you said that if you just look at it from a financial perspective of (when) you’re paid a certain amount to manage a population and keep them healthy, what are the catastrophic threats that could completely decimate that population and put a certain percentage of them in the ICU for three months? It’s communicable disease. We have to not only plan for that but have the ability to see the risk in real time, take action to protect the populations in real time. And it’s not just an economic incentive, it’s a national security incentive. So, it’s a long way of saying I completely agree with you, but no tools existed, and we’re building them.

[00:37:01.830] Don Crane:

Well, I think we’ve got some work to do, frankly, Charity. So, I think between now and December 11, or when you ever come down to San Diego and talk to our members and our audience, we should give some further thoughts to this very thing. So, I think that’s our challenge. Let’s talk further and see if we can’t address that a little more specifically. Maybe I can set up some kind of a focus group with some of our members and some of our own data scientists and get to work on this. Does that sound like a reasonable request?

[00:37:35.130] Charity Dean, MD:

Yeah, it does. Sure, I’d be happy to. And I’m always learning so I would love to hear from their perspective what levers they have at their fingertips to pull right now and what levers they don’t have, because it helps to inform us as we build the tools where a healthcare system or a payer network can make a difference at containing a threat.

[00:37:58.710] Don Crane:

Well, I can remember talking with Paul Markovich, and eventuate, quite as I spoke with him, this is when the task force that you and he were co-chairing and I said, Paul, my members are ready, willing, and able to serve as conduits of information and also have the present ability, given that they’re organized, given that they have networks of physicians, given that they have systems in place, we’re in a position to rapidly vaccinate large numbers of patients, and so we’re available to do it. It didn’t happen in that way and that’s fine…but, at any rate, I just think that there’s some alignment and some affinity here between public health and basically population health, which we typically think about that hasn’t yet been fully kind of considered, analyzed, and acted upon. So anyway, there’s our assignment, Charity, I really want to thank you for the time. I see that our clock is running out on me. So, thank you very much for the podcast and stay well and then we’ll be talking soon, okay?

[00:39:06.330] Charity Dean, MD:

It’s my pleasure. Absolutely, I look forward to more conversations.

[00:39:10.530] Don Crane:

As you may have observed, our annual conference this year will now be held in person December 9 through December 11 at the Marriott Marquis San Diego Marina. Please save the date and be sure to register. It will be, to say the least, an extraordinarily welcome and refreshing chance to see each other in person once again. In the meantime, stay safe and be well.